FDA approves first drug for treatment of peanut allergy for children - FDA Press Releases

FDA approves first drug for treatment of peanut allergy for children
Treatment with this product may be initiated in individuals ages 4 through 17 years with a confirmed diagnosis of peanut allergy and may be continued in individuals 4 years of age and older.

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MICHAEL GORDON AND HUMANISM - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Geriatric Psychiatry - Geriatrics

The evidence base for treating older adults with psychiatric disorders is ever increasing, yet few persons are trained to treat the elderly through geriatric psychiatry fellowship training programs. Therefore, the bulk of patient care devolves to general psychiatrists, primary care practitioners, and mental health professionals other than psychiatrists. Even so, specialty-trained geriatric psychiatrists must keep up with the latest in our understanding of psychiatric disorders and their comorbidities among older adults.

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FDA launches mobile-friendly database with information on life-saving HIV drugs as part of ongoing mission to empower the public through increased access to information and data - FDA Press Releases

FDA launches an interactive database that will offer a wealth of critical information about antiretrovirals (ARVs) eligible for purchase under the President’s Emergency Plan for AIDS Relief (PEPFAR) program.

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Assessment of Medication Management Competency Among Medical Students Using Standardized Patients - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Thirty‐Day Hospital Readmissions in a Care Transitions Program for High‐Risk Older Adults - American Geriatric Society

OBJECTIVES

To describe the causes of 30‐day hospital readmissions among high‐risk older adults during implementation of a multicomponent care transitions program.

DESIGN

Secondary analysis of data from the evaluation of a multicomponent care transitions program for hospitalized high‐risk older adults.

SETTING

A 400‐bed community teaching hospital.

PARTICIPANTS

Patients aged 75 and older admitted to non–intensive care unit beds who met specific criteria for high risk of complications and hospital readmissions. The intervention group included 202 patients, of whom 37 were readmitted to the hospital as an inpatient or on observation status within 30 days of discharge.

MEASUREMENTS

Root‐cause analyses on each readmission were conducted by hospital physicians and post‐acute care (PAC) organization staff. Additional data were collected by trained project staff using the medical record and postdischarge telephone or in‐person follow‐up visits. These data were reviewed and adjudicated among the authors, and each readmission was rated with unanimous agreement as “preventable,” “possibly preventable,” or “not preventable.”

RESULTS

No significant differences were found in demographic and clinical characteristics of intervention patients readmitted versus those not readmitted. A higher proportion of the 37 patients who were readmitted did not have a postdischarge visit than the 165 patients who were not readmitted (15 [41%] vs 45 [27%]; P = .11). Among the 37 readmissions, 14 (38%) were rated as not preventable, 14 (38%) as possibly preventable, and 9 (24%) as preventable. Readmissions were rated as preventable or possibly preventable for a variety of reasons that provide insight into how care transitions programs for high‐risk older adults might be made more effective.

CONCLUSION

Root‐cause analyses of hospital readmissions among high‐risk older adults by hospital physicians and PAC providers can identify strategies that might enhance the effectiveness of care transitions interventions in this complex population.

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Electroconvulsive Therapy in Geriatric Psychiatry - Geriatrics

Electroconvulsive therapy (ECT) remains an important treatment of geriatric patients. ECT treats severe depression, mania, psychosis, catatonia, and comorbid depression and agitation in dementia. ECT also serves a crucial role in treating urgent illness requiring expedient recovery, such as catatonia, or in patients with severe suicidal ideation or intent. ECT is even more effective in the elderly than in mixed-age adult populations. ECT is a safe treatment option with few medical contraindications. Cognitive effects are largely transient, even in patients with preexisting cognitive impairment.

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Cognitive Reserve from the Perspective of Preclinical Alzheimer Disease - Geriatrics

The concept of cognitive reserve (CR) was proposed to account for the discrepancy between levels of brain pathologic process or damage and clinical and cognitive function. We provide a detailed review of prospective longitudinal studies that have investigated the interaction between CR and Alzheimer disease (AD) biomarkers on clinical and cognitive outcomes among individuals with normal cognition at baseline. Current evidence is consistent with the view that higher levels of CR are associated with a delay in the onset of symptoms of mild cognitive impairment and that there may be multiple pathways by which CR exerts its protective effects.

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Depression and Cardiovascular Disorders in the Elderly - Geriatrics

The world’s older population continues to grow at an unprecedented rate. This trend amplifies the necessity of improving the care of older patients with chronic health problems. Of those with chronic health problems, those with cardiovascular diseases and depression are particularly challenging due to the multifaceted nature of these conditions. This review discusses the significance of this aging trend and ways to better care for this particular population.

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FDA Continues Strong Support of Innovation in Development of Gene Therapy Products - FDA Press Releases

FDA Continues Strong Support of Innovation in Development of Gene Therapy Products

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Synergistic anti-methicillin-resistant Staphylococcus aureus (MRSA) activity and absolute stereochemistry of 7,8-dideoxygriseorhodin C - Journal of Antibiotics

The Journal of Antibiotics, Published online: 28 January 2020; doi:10.1038/s41429-019-0275-8

Synergistic anti-methicillin-resistant Staphylococcus aureus (MRSA) activity and absolute stereochemistry of 7,8-dideoxygriseorhodin C

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Ferrocenyl chalcone derivatives as possible antimicrobial agents - Journal of Antibiotics

The Journal of Antibiotics, Published online: 28 January 2020; doi:10.1038/s41429-020-0280-y

Ferrocenyl chalcone derivatives as possible antimicrobial agents

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FDA Announces Key Actions to Advance Development of Novel Coronavirus Medical Countermeasures - FDA Press Releases

FDA Announces Key Actions to Advance Development of Novel Coronavirus Medical Countermeasures

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Author Index for Volume 72 - Journal of Antibiotics

The Journal of Antibiotics, Published online: 27 January 2020; doi:10.1038/s41429-019-0255-z

Author Index for Volume 72

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Substance Index for Volume 72 - Journal of Antibiotics

The Journal of Antibiotics, Published online: 27 January 2020; doi:10.1038/s41429-019-0260-2

Substance Index for Volume 72

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Do Higher Payments Increase Access to Post‐Acute Home Health Care for Rural Medicare Beneficiaries? - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Time Spent Away from Home in the Year Following High‐Risk Cancer Surgery in Older Adults - American Geriatric Society

OBJECTIVES

To understand where older adults spend time (at home, in the hospital, or in a nursing home) in the year following high‐risk cancer surgery.

DESIGN

Retrospective cohort study.

SETTING

Medicare beneficiaries using data from Medicare Inpatient claims to ascertain hospital days and the Minimum Data Set to ascertain nursing home days.

PARTICIPANTS

Beneficiaries who underwent high‐risk cancer surgery (cystectomy, pancreaticoduodenectomy, gastrectomy, or esophagectomy) were identified to determine cumulative time spent away from home in the year following surgery.

MEASUREMENTS

Adjusted percentages of time spent away from home (ie, days in a hospital or nursing home) were modeled for the year following surgery.

RESULTS

A total of 37 748 beneficiaries underwent high‐risk cancer surgery during the study period, and 28.3% died within 1 year. Overall, beneficiaries spent 13.9 ± 26.2 days in the hospital (over 1.5 ± 2.0 hospital readmissions) and 37.2 ± 50.6 days in the nursing home (over 1.5 ± 1.0 admissions) in the year following surgery. Among beneficiaries who were alive and dead at 1 year, 18.5% and 30.1% of time was spent away from home, respectively. Beneficiaries who were initially discharged to a facility following surgery and died within 1 year spent 44.4% of their final year away from home.

CONCLUSION

Time spent away from home in the hospital and/or nursing home in the year following high‐risk cancer surgery is substantial among Medicare beneficiaries. This information is crucial in counseling patients on postoperative expectations and may additionally influence preoperative decision making.

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Prospective Associations Between Diffusion Tensor Imaging Parameters and Frailty in Older Adults - American Geriatric Society

BACKGROUND

Cross‐sectional associations have been found between frail individuals and worse white matter (WM) integrity. However, the prospective association between WM integrity and frailty is still unclear. Our objectives were to measure associations between WM integrity using diffusion tensor imaging (DTI) and the 5‐year worsening of frailty in community‐dwelling older adults.

DESIGN

Secondary analysis of the randomized controlled Multidomain Alzheimer Preventive Trial (MAPT).

SETTING

Thirteen memory centers in France and Monaco between 2008 and 2011.

PARTICIPANTS

Participants (mean age = 74.7 ± 3.9 years) with no dementia at baseline who had functional magnetic resonance imaging performed as part of the MAPT study (n = 227).

MEASUREMENTS

Fractional anisotropy and mean diffusivity (MD), axial diffusivity (AxD), and radial diffusivity (RD) were acquired for 10 different brain regions. Frailty was assessed by the Fried frailty phenotype (score from 0 to 5, higher is worse) at up to seven time points for 5 years. Mixed effect ordinal logistic regression model was used to assess the prospective association between DTI parameters (independent variables) and frailty (dependent variable). All the analyses were adjusted for age, sex, baseline total intracranial volume, and the presence of one of the following cardiovascular risk factors (hypertension, diabetes, and/or hypercholesterolemia).

RESULTS

A statistically significant association was found between the RD, AxD, and MD for different brain regions (anterior limb of internal capsule, external capsule, posterior corona radiata, posterior thalamic radiation, superior corona radiata, superior frontal occipital fasciculus, and superior longitudinal fasciculus) and worsening of frailty over 5 years after adjusting for multiple comparisons.

CONCLUSIONS

This is the first study to show that WM integrity is associated with frailty in older adults. The mechanisms related to these results require further investigation.

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Postmenopausal Breast Cancer and Physical Function Change: A Difference‐in‐Differences Analysis - American Geriatric Society

BACKGROUND/OBJECTIVES

While breast cancer and associated therapies can influence physical function (PF), findings for breast cancer's effects on PF among postmenopausal women are not consistent. This research evaluates the effect of breast cancer on change in PF.

DESIGN

Longitudinal cohort study analyzed using difference‐in‐differences (DID) method to compare the changes in PF over time between women with and without breast cancer, by invasive status, stage, and age.

SETTING AND PARTICIPANTS

Women's Health Initiative participants, aged 50 to 79 years at baseline, with four completed functional status assessments were eligible for inclusion (mean age = 62.1 ± 6.9 years). Women with breast cancer diagnosed between the 3rd and 11th enrollment year (n = 1636) were compared to women without breast cancer (n = 35 660).

MEASUREMENTS

PF was measured using the Medical Outcomes Study Short Form 36 at baseline and years 3, 11, and 12.

RESULTS

Compared with women without breast cancer, women with breast cancer experienced greater PF decline (P < .0001), after adjustment for age, race, education, income, study/trial arm, and body mass index. Overall, functional declines were greatest among women with invasive breast cancer (DID = −4.87; 95% confidence interval = −7.12 to −2.62). In stratified analyses, the breast cancer effect on PF was greater among women in older age groups.

CONCLUSION

Women diagnosed with breast cancer experienced a significant decline in PF beyond what is observed in typical aging in this cohort. To optimally address survivorship issues, disease sequelae need to be distinguished from normal aging in studies incorporating a cancer‐free comparison group.

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Inappropriate Antipsychotic Use: The Impact of Nursing Home Socioeconomic and Racial Composition - American Geriatric Society

OBJECTIVES

Previous research suggests black nursing home (NH) residents are more likely to receive inappropriate antipsychotics. Our aim was to examine how NH characteristics, particularly the racial and socioeconomic composition of residents, are associated with the inappropriate use of antipsychotics.

DESIGN

This study used a longitudinal approach to examine national data from Long‐Term Care: Facts on Care in the US (LTCFocUS.org) between 2000 and 2015. We used a multivariate linear regression model with year and state fixed effects to estimate the prevalence of inappropriate antipsychotic use at the NH level.

SETTING

Free‐standing NHs in the United States.

PARTICIPANTS

The sample consisted of 12 964 NHs.

MEASUREMENTS

The outcome variable was inappropriate antipsychotic use at the facility level. The primary indicator variables were whether a facility had high proportions of black residents and the percentage of residents with Medicaid as their primary payer.

RESULTS

NHs with high and low proportions of blacks had similar rates of antipsychotic use in the unadjusted analyses. NHs with high proportions of black residents had significantly lower rates of inappropriate antipsychotic use (β = −2; P < .001) in the adjusted analyses. Facilities with high proportions of Medicaid‐reliant residents had higher proportions of inappropriate use (β = .04; P < .001).

CONCLUSION

Findings from this study indicate a decline in the use of antipsychotics. Although findings from this study indicated facilities with higher proportions of blacks had lower inappropriate antipsychotic use, facility‐level socioeconomic disparities continued to persist among NHs. Policy interventions that focus on reimbursement need to be considered to promote reductions in antipsychotic use, specifically among Medicaid‐reliant NHs.

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Critical Workforce Gaps in Dementia Education and Training - American Geriatric Society

The US Department of Health and Human Services and the Foundation for the National Institutes of Health, through private sector support, sponsored the National Research Summit on Dementia Care: Building Evidence for Services and Supports (Summit) in 2017. Various workgroups were asked to address topics of interest in dementia care and develop recommendations addressing the goals of the Summit. Workforce education and training was identified to be a key issue. As a result, a Workforce Development Workgroup (the Workgroup) was created and addressed two of the Summitʼs goals. The first goal is to improve the quality of care and support provided to persons living with dementia and those who care for them. The second goal is to accelerate the development, evaluation, translation, implementation, and scaling‐up of evidence‐based and evidence‐informed services for persons living with dementia, their families, and caregivers. In this article, the Workgroup identified gaps in educating and training a dementia‐capable workforce. The Workgroup consisted of an interprofessional team with expertise in dementia workforce development from academia, professional organizations, and the federal government. Four recommendations are presented concerning research topics that will advance the education and training of a dementia‐capable workforce, which includes health professions students, faculty, practitioners, direct care workers, persons living with dementia, and those who care for them.

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Geriatric Conditions Predict Discontinuation of Anticoagulation in Long‐Term Care Residents With Atrial Fibrillation - American Geriatric Society

BACKGROUND

Anticoagulation (AC) for stroke prevention in long‐term care (LTC) residents with atrial fibrillation (AF) involves a challenging risk‐benefit evaluation. We measured the association of geriatric conditions with discontinuation of AC.

DESIGN

Retrospective cohort analysis.

SETTING

LTC facilities across the United States.

PARTICIPANTS

A total of 48 545 individuals residing in LTC facilities in 2015 with AF and sufficient information to establish their status as someone who stopped AC vs someone who continued AC.

MEASUREMENTS

We measured the association of six geriatric conditions—recent fall, severe activity of daily living (ADL) dependency (21‐28 on a 28‐point scale), mobility impairment, cognitive impairment, body mass index (BMI) less than 18.5 kg/m², and weight loss (≥5% in 1 month or ≥10% in 6 months)—with discontinuation of AC. To identify cases of discontinuation, we required a pattern of being on AC over two consecutive recordings of the Minimum Data Set, the nursing home quality control data set recorded every 90 days, followed by two assessments being off AC—pattern of “on‐on‐off‐off.” By contrast, we required a pattern of “on‐on‐on‐on” for continuers. We then constructed six logistic regression models to measure the independent association between each geriatric condition and discontinuation of AC, adjusted for CHA₂DS₂‐VASc stroke risk score, recent bleeding hospitalization, and other confounders.

RESULTS

There were 4172 discontinuers and 44 373 continuers. Recent fall predicted a 1.9‐fold increase in the odds of discontinuation (odds ratio = 1.91; 95% confidence interval = 1.66‐2.20), whereas mobility and cognitive impairment only increased the odds by 14% to 17%. Severe ADL dependency, BMI less than 18.5 kg/m², and weight loss of 10% each increased odds of discontinuation by 55% to 68%. CHA₂DS₂‐VASc score did not predict discontinuation.

CONCLUSION

Several geriatric conditions predicted discontinuation of AC, whereas CHA₂DS₂‐VASc score did not. Future research should examine the association of geriatric conditions and discontinuation of warfarin discrete from newer anticoagulants and association of geriatric conditions with development of stroke and bleeding.

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Primary Prevention Statins in Older Adults: Personalized Care for a Heterogeneous Population - American Geriatric Society

The 2018 American College of Cardiology/American Heart Association guidelines on the management of cholesterol acknowledge a lack of robust randomized clinical trial data to support routine use of statin therapy for primary prevention in adults older than 75 years. Shared decision making is emphasized because potential recommendations should reflect limitations of the current data, as well as heterogeneity of the older adult population, spanning the robust to the most frail. Although the National Institute on Aging recently funded PRagmatic EValuation of EvENTs And Benefits of Lipid‐Lowering in OldEr Adults (PREVENTABLE), a trial to study benefits of statins in very old adults, data are not anticipated for 5 years. Thus interim guidance is essential. Furthermore, even when PREVENTABLE is completed, individual idiosyncrasies among older adults suggest that decisions for each patient will still need to be personalized, relative to their unique clinical situation. In this article, we present three case studies to highlight dynamics that commonly impact choices regarding statins in older adults. Details underlying shared decision making are also described including the evolving application of coronary artery calcium to inform this practice.

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Aligning the 4Ms of Age‐Friendly Health Systems With Statin Use for Primary Prevention - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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FDA approves first treatment option specifically for patients with epithelioid sarcoma, a rare soft tissue cancer - FDA Press Releases

FDA granted accelerated approval to Tazverik (tazemetostat) for the treatment of adults and pediatric patients aged 16 years and older with metastatic or locally advanced epithelioid sarcoma not eligible for complete resection

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FDA informs health care providers, facilities and patients about potential cybersecurity vulnerabilities for certain GE Healthcare Clinical Information Central Stations and Telemetry Servers - FDA Press Releases

FDA is issuing a safety communication informing health care providers, facilities and patients about cybersecurity vulnerabilities identified for certain GE Healthcare Clinical Information Central Stations and Telemetry Servers.

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Anti-inflammatory effects of ozenoxacin, a topical quinolone antimicrobial agent - Journal of Antibiotics

The Journal of Antibiotics, Published online: 23 January 2020; doi:10.1038/s41429-020-0278-5

Anti-inflammatory effects of ozenoxacin, a topical quinolone antimicrobial agent

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Polyketide glycosides phialotides A to H, new potentiators of amphotericin B activity, produced by Pseudophialophora sp. BF-0158 - Journal of Antibiotics

The Journal of Antibiotics, Published online: 23 January 2020; doi:10.1038/s41429-019-0276-7

Polyketide glycosides phialotides A to H, new potentiators of amphotericin B activity, produced by Pseudophialophora sp. BF-0158

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The Impact of Psychological Status, Social Well‐Being, and Physical Function on Healthcare Utilization - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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FDA approves first treatment for thyroid eye disease - FDA Press Releases

FDA approved Tepezza for the treatment of adults with thyroid eye disease. Today’s approval represents the first drug approved for the treatment of thyroid eye disease.

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Clock Draw - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Failure of Traditional Risk Factors to Adequately Predict Cardiovascular Events in Older Populations - American Geriatric Society

BACKGROUND

Accurate assessment of atherosclerotic cardiovascular disease (ASCVD) risk across heterogeneous populations is needed for effective primary prevention. Little is known about the performance of standard cardiovascular risk factors in older adults.

OBJECTIVE

To evaluate the performance of the American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE) risk model, as well as the underlying cardiovascular risk factors, among adults older than 65 years.

DESIGN AND SETTING

Retrospective cohort derived from a regional referral system's electronic medical records.

PARTICIPANTS

A total of 25 349 patients who were 65 years or older at study baseline (date of the first outpatient lipid panel taken between 2007 and 2010).

MEASUREMENTS

Exposures of interest were traditional cardiovascular risk factors, as defined by inclusion in the PCE model. The primary outcome was major ASCVD events, defined as a composite of myocardial infarctions, stroke, and cardiovascular death.

RESULTS

The PCE and internally estimated models produced similar risk distributions for white men aged 65 to 74 years. For all other groups, PCE predictions were generally lower than those of the internal models, particularly for African Americans. Discrimination of the PCE was poor for all age groups, with concordance index (95% confidence interval) estimates of 0.62 (0.60‐0.64), 0.56 (0.54‐0.57), and 0.52 (0.49‐0.54) among patients aged 65 to 74, 75 to 84, and 85 years and older, respectively. Reestimating relationships within these age groups resulted in better calibration but negligible improvements in discrimination. Blood pressure, total cholesterol, and diabetes either were not associated at all or had inverse associations in the older age groups.

CONCLUSION

Traditional clinical risk factors for cardiovascular disease failed to accurately characterize risk in a contemporary population of Medicare‐aged patients. Among those aged 85 years and older, some traditional risk factors were not associated with ASCVD events. Better risk models are needed to appropriately inform treatment decision making for the growing population of older adults.

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Unplanned Hospital Care Use in Older Adults: The Role of Psychological and Social Well‐Being - American Geriatric Society

OBJECTIVES

To explore the association of psychological and social well‐being with unplanned hospital utilization in an older Swedish population.

DESIGN

Data for this study were gathered from the Swedish National Study on Aging and Care in Kungsholmen (SNAC‐K). Information on hospital care use was extracted from the Stockholm County Council Inpatient Register for up to 4 years after the baseline SNAC‐K assessment (2001‐2007). Participants with dementia or living in institutions were excluded from the study sample.

SETTING

Community‐based study of randomly selected adults, aged 60 years or older, living in the Kungsholmen district of Stockholm.

PARTICIPANTS

A complete case analysis was performed on 2139 individuals.

MEASUREMENTS

We created standardized indexes of psychological well‐being (integrating life satisfaction and positive and negative affect) and social well‐being (integrating social connections, support, and participation). Negative binomial models were used to estimate the association of psychosocial well‐being with unplanned admissions, hospital days, and 30‐day readmissions, considering potential sociodemographic, lifestyle, personality, and clinical confounders.

RESULTS

Individuals with psychological well‐being scores above the median had lower rates of unplanned hospital admissions (incidence rate ratio [IRR] = 0.67; 95% confidence interval [CI] = 0.55‐0.82) and hospital days (IRR = 0.67; 95% CI = 0.49‐0.92) compared to those with scores below the median. High levels of social well‐being were also protective for unplanned admissions and hospital days, but the statistical significance was lost in the fully adjusted models. Relative to individuals with low well‐being on both indexes, the rate of unplanned admissions and hospital days was lowest in those with both high psychological and social well‐being (IRR = 0.72; 95% CI = 0.55‐0.93; and IRR = 0.57; 95% CI = 0.39‐0.85, respectively). For 30‐day readmissions, a statistically significant negative association was found with psychological well‐being, but only when operationalized as a continuous variable.

CONCLUSION

Given their association with unplanned admissions and hospital days, targeting aspects of psychosocial well‐being could be a viable strategy for reducing healthcare use and, eventually, costs.

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Genetic insights into the mechanism of teicoplanin self-resistance in Actinoplanes teichomyceticus - Journal of Antibiotics

The Journal of Antibiotics, Published online: 17 January 2020; doi:10.1038/s41429-019-0274-9

Genetic insights into the mechanism of teicoplanin self-resistance in Actinoplanes teichomyceticus

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Streptovertimycins A–H, new fasamycin-type antibiotics produced by a soil-derived Streptomyces morookaense strain - Journal of Antibiotics

The Journal of Antibiotics, Published online: 17 January 2020; doi:10.1038/s41429-020-0277-6

Streptovertimycins A–H, new fasamycin-type antibiotics produced by a soil-derived Streptomyces morookaense strain

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Statement on quality issues with certain Cardinal Health surgical gowns and packs - FDA Press Releases

Statement from Jeff Shuren, M.D., J.D., director of FDA’s Center for Devices and Radiological Health on quality issues with certain Cardinal Health surgical gowns and packs

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Statement on the Salinas-linked romaine lettuce E. coli O157:H7 outbreak and status update on investigation - FDA Press Releases

Romaine outbreaks declared over, investigation advances, root cause analysis continues

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Synthesis of water-soluble prodrugs of 5-modified 2ʹ-deoxyuridines and their antibacterial activity - Journal of Antibiotics

The Journal of Antibiotics, Published online: 14 January 2020; doi:10.1038/s41429-019-0273-x

Synthesis of water-soluble prodrugs of 5-modified 2ʹ-deoxyuridines and their antibacterial activity

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Mortality and Cholesterol Metabolism in Subjects Aged 75 Years and Older: The Helsinki Businessmen Study - American Geriatric Society

BACKGROUND/OBJECTIVES

In many studies, low serum cholesterol is paradoxically associated with a higher mortality risk among older adults. Therefore, we studied whole‐body cholesterol metabolism and its role in all‐cause mortality of older men in two subcohorts of different ages.

DESIGN

Prospective long‐term cohort.

SETTING

Home‐dwelling men of the Helsinki Businessmen Study.

PARTICIPANTS

Two partly overlapping subcohorts were recruited, in 2003 (n = 660; mean age = 76 years) and in 2011 (n = 398; mean age = 83 years). The younger subcohort was followed up after 3 and 11 years, and the older subcohort was followed up after 3 years.

MEASUREMENTS

Cholesterol metabolism was assessed via serum noncholesterol sterol‐cholesterol ratios, and quantification was performed by gas‐liquid chromatography with flame ionization detection. All statistical analyses were performed with age and statin treatment as covariates.

RESULTS

At the end of the 3‐year follow‐up, 10% of the younger and 13% of the older subcohort had died; and at the end of the 11‐year follow‐up, 40% of the younger subcohort had died. Serum total and low‐density lipoprotein (LDL) cholesterol and cholesterol precursors reflecting cholesterol synthesis were lower in the older than in the younger subcohort (P < .001 for all). In the older subcohort, low serum campesterol and sitosterol, reflecting decreased cholesterol absorption efficiency, predicted all‐cause mortality (P < .05). This was supported by a trend toward low serum campesterol and sitosterol predicting mortality (P = .088 and P = .079, respectively) in the younger subcohort after 11 years. Cholesterol synthesis did not predict mortality, but in the older subcohort, decreased cholesterol absorption was less efficiently compensated for by decreased cholesterol synthesis.

CONCLUSIONS

Low cholesterol absorption efficiency predicted all‐cause mortality, especially in men aged 83 years on average, and cholesterol synthesis was lowered. These metabolic changes could contribute to the lowering of serum total and LDL‐cholesterol in older men.

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Associations between Serum Levels of Cholesterol and Survival to Age 90 in Postmenopausal Women - American Geriatric Society

OBJECTIVES

Although elevated lipid levels predict increased risk of coronary heart disease and death in middle‐aged women and men, evidence is mixed if lipid levels measured in later life predict survival to very old ages. We examined lipid levels and survival to age 90 with or without intact mobility in a large cohort of older women.

DESIGN

Prospective cohort.

SETTING

Laboratory collection at a Women's Health Initiative (WHI) center and longitudinal follow‐up via mail.

PARTICIPANTS

Women aged 68 to 81 years at baseline.

MEASUREMENTS

Serum high‐density lipoprotein (HDL) and low‐density lipoprotein (LDL) cholesterol were collected at baseline. Participant survival status and self‐reported mobility was compared across lipid levels.

RESULTS

HDL and LDL levels were not associated with survival to age 90 after adjustment for cardiovascular risk factors (HDL: quartile (Q) 2: odds ratio [OR] = 1.14 [95% confidence interval [CI] = .94‐1.38]; Q3 OR = 1.08 [95% CI = .88‐1.33]; Q4 OR = 1.09 [95% CI = .88‐1.35]; LDL: Q2 OR = 1.07 [95% CI = .88‐1.31]; Q3 OR = 1.27 [95% CI = 1.04‐1.55]; Q4 OR = 1.07 [95% CI = .88‐1.31]). Similarly, no associations were observed between HDL and LDL levels and survival to age 90 with mobility disability. High HDL was not associated with survival to age 90 with intact mobility after adjustment for other cardiovascular risk factors. Compared with the lowest LDL quartile, the three upper LDL quartiles were associated with greater odds of survival to age 90 with intact mobility (LDL: Q2 OR = 1.31 [95% CI = .99‐1.74]; Q3 OR = 1.43 [95% CI = 1.07‐1.92]; Q4 OR = 1.35 [95% CI = 1.01‐1.80]; P = .05).

CONCLUSION

Neither higher HDL nor lower LDL levels predicted survival to age 90, but higher LDL predicted healthy survival. These findings suggest the need for reevaluation of healthy LDL levels in older women.

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The Impact of Home Health Physical Therapy on Medicare Beneficiaries With a Primary Diagnosis of Dementia - American Geriatric Society

BACKGROUND

Dementia is a leading cause of disability for adults older than 65 years. Exercise intervention slows functional decline and improves balance; however, the efficacy of physical therapy (PT) services for persons with dementia is unknown. The purpose of this study is to assess the effect of home health PT services on physical function for Medicare beneficiaries with a primary diagnosis of dementia.

DESIGN

Observational cohort study using a combined Medicare data set of home health beneficiaries; we performed augmented inverse probability weighted regression with demographic, comorbidity, and symptom‐level characteristics analyzed as covariates.

SETTING

Home healthcare, United States, 2012.

PARTICIPANTS

Medicare beneficiaries who had a primary diagnosis of dementia and home health function evaluations at discharge (n = 1477).

INTERVENTION

PT treatment, examined by (1) any PT and (2) PT visit number.

MEASUREMENT

Improvement in composite activity of daily living (ADL) scores from home health admit to discharge.

RESULTS

Any PT increased the probability of improvement in ADLs by 15.2% (P < .001). Compared to 1 to 5 PT visits, 6 to 13 visits increased the probability of ADL improvement by 11.6% (P < .001).

CONCLUSION

PT intervention is beneficial for ADL function improvement in Medicare home health beneficiaries with a primary diagnosis of dementia.

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The Highs and Lows of Cholesterol: A Paradox of Healthy Aging? - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Michigan-based food manufacturer agrees to stop production after repeated food safety violations - FDA Press Releases

Home Style Foods, Inc., a Michigan-based food manufacturer, has agreed to discontinue selling food products until the company complies with federal regulations and other requirements.

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Advances in the Conceptualization and Study of Schizophrenia in Later Life: 2019 Update - Geriatrics

A crisis looms as research and clinical programs have not kept pace with dramatic increases in the number of older adults with schizophrenia. This article provides an overview of the advances in the conceptualization and study of schizophrenia in later life. Theoretic and clinical models in psychiatry and gerontology are integrated. Specifically, recovery is examined in the context of aging, how clinical dimensionality affects diagnoses in older adults, how various features of schizophrenia are implicated in models of accelerated and paradoxic aging, and how outcome in later life is a more dynamic and heterogeneous than assumed previously.

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High‐Need Phenotypes in Medicare Beneficiaries: Drivers of Variation in Utilization and Outcomes - American Geriatric Society

OBJECTIVES

High‐need (HN) Medicare beneficiaries heavily use healthcare services at a high cost. This population is heterogeneous, composed of individuals with varying degrees of medical complexity and healthcare needs. To improve healthcare delivery and decrease costs, it is critical to identify the subpopulations present within this population. We aimed to (1) identify distinct clinical phenotypes present within HN Medicare beneficiaries, and (2) examine differences in outcomes between phenotypes.

DESIGN

Latent class analysis was used to identify phenotypes within a sample of HN fee‐for‐service (FFS) Medicare beneficiaries aged 65 years and older using Medicare claims and post‐acute assessment data.

SETTING

Not applicable.

PARTICIPANTS

Two cross‐sectional cohorts were used to identify phenotypes. Cohorts included FFS Medicare beneficiaries aged 65 and older who survived through 2014 (n = 415 659) and 2015 (n = 416 643).

MEASUREMENTS

The following variables were used to identify phenotypes: acute and post‐acute care use, functional dependency in one or more activities of daily living, presence of six or more chronic conditions, and complex chronic conditions. Mortality, hospitalizations, healthcare expenditures, and days in the community were compared between phenotypes.

RESULTS

Five phenotypes were identified: (1) comorbid ischemic heart disease with hospitalization and skilled nursing facility use (22% of the HN sample), (2) comorbid ischemic heart disease with home care use (23%), (3) home care use (12%), (4) high comorbidity with hospitalization (32%), and (5) Alzheimer's disease/related dementias with functional dependency and nursing home use (11%). Mortality was highest in phenotypes 1 and 2; hospitalizations and expenditures were highest in phenotypes 1, 3, and 4.

CONCLUSIONS

Our findings represent a first step toward classifying the heterogeneity among HN Medicare beneficiaries. Further work is needed to identify modifiable utilization patterns between phenotypes to improve the value of healthcare provided to these subpopulations. J Am Geriatr Soc 68:70–77, 2019

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GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data - American Geriatric Society

OBJECTIVES

We aimed to describe a new multidisciplinary team fall prevention intervention for older adults who seek care in the emergency department (ED) after having a fall, assess its feasibility and acceptability, and review lessons learned during its initiation.

DESIGN

Single‐blind randomized controlled pilot study.

SETTING

Two urban academic EDs

PARTICIPANTS

Adults 65 years old or older (n = 110) who presented to the ED within 7 days of a fall.

INTERVENTION

Participants were randomized to a usual care (UC) and an intervention (INT) arm. Participants in the INT arm received a brief medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist (PT). INT participants received referrals to outpatient services (eg, home safety evaluation, outpatient PT).

MEASUREMENTS

We used participant, caregiver, and clinician surveys, as well as electronic health record review, to assess the feasibility and acceptability of the intervention.

RESULTS

Of the 110 participants, the median participant age was 81 years old, 67% were female, 94% were white, and 16.3% had cognitive impairment. Of the 55 in the INT arm, all but one participant received the pharmacy consult (98.2%); the PT consult was delivered to 83.6%. Median consult time was 20 minutes for pharmacy and 20 minutes for PT. ED length of stay was not increased in the INT arm: UC 5.25 hours vs INT 5.0 hours (P < .94). After receiving the Geriatric Acute and Post‐acute Fall Prevention Intervention (GAPcare), 100% of participants and 97.6% of clinicians recommended the pharmacy consult, and 95% of participants and 95.8% of clinicians recommended the PT consult.

CONCLUSION

These findings support the feasibility and acceptability of the GAPcare model in the ED. A future larger randomized controlled trial is planned to determine whether GAPcare can reduce recurrent falls and healthcare visits in older adults. J Am Geriatr Soc 68:198–206, 2019

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Decisional Guidance Tool for Antibiotic Prescribing in the Skilled Nursing Facility - American Geriatric Society

OBJECTIVES

To derive weighted‐incidence syndromic combination antibiograms (WISCAs) in the skilled nursing facility (SNF). To compare burden of resistance between SNFs in a region and those with and without protocols designed to reduce inappropriate antibiotic use.

DESIGN

Retrospective analysis of microbial data from a regional laboratory.

SETTING

We analyzed 2484 isolates collected at a regional laboratory from a large mixed urban and suburban area from January 1, 2015, to December 31, 2015.

PARTICIPANTS

A total of 28 regional SNFs (rSNFs) and 7 in‐network SNFs (iSNFs).

MEASUREMENTS

WISCAs were derived combining Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and reports restricted to fluoroquinolones, cefazolin, amoxicillin clavulanate, and trimethoprim/sulfamethoxazole.

RESULTS

Pooling the target isolates into WISCAs resulted in an average of 28 of 37 achieving a number greater than 30 with an average of 50 isolates (range = 11‐113; >97% urinary). Significant differences were found in antibiotic susceptibility between grouped rSNF data and iSNF data of 75% vs 65% (2.76‐11.77; P = .002). The susceptibilities were higher in iSNFs with active antibiotic reduction protocols compared with iSNFs without protocols and rSNFs (effect size = .79 vs .67 and .65, respectively) (I² = 93.33; P < .01). Susceptibilities to cefazolin (95% vs 76%; P < .001) and fluoroquinolones (72% vs 64%; P = .048) were significantly higher in iSNFs with active urinary tract infection protocols as compared with iSNFs without antibiotic reduction protocols.

CONCLUSION

These results suggest that WISCAs can be developed in most SNFs, and their results can serve as indicators of successful antibiotic stewardship programs. J Am Geriatr Soc 68:55–61, 2019

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A 2‐Year Pragmatic Trial of Antibiotic Stewardship in 27 Community Nursing Homes - American Geriatric Society

OBJECTIVES

To determine if antibiotic prescribing in community nursing homes (NHs) can be reduced by a multicomponent antibiotic stewardship intervention implemented by medical providers and nursing staff and whether implementation is more effective if performed by a NH chain or a medical provider group.

DESIGN

Two‐year quality improvement pragmatic implementation trial with two arms (NH chain and medical provider group).

SETTING

A total of 27 community NHs in North Carolina that are typical of NHs statewide, conducted before announcement of the US Centers for Medicare and Medicaid Services antibiotic stewardship mandate.

PARTICIPANTS

Nursing staff and medical care providers in the participating NHs.

INTERVENTION

Standardized antibiotic stewardship quality improvement program, including training modules for nurses and medical providers, posters, algorithms, communication guidelines, quarterly information briefs, an annual quality improvement report, an informational brochure for residents and families, and free continuing education credit.

MEASUREMENTS

Antibiotic prescribing rates per 1000 resident days overall and by infection type; rate of urine test ordering; and incidence of Clostridium difficile and methicillin‐resistant Staphylococcus aureus (MRSA) infections.

RESULTS

Systemic antibiotic prescription rates decreased from baseline by 18% at 12 months (incident rate ratio [IRR] = 0.82; 95% confidence interval [CI] = 0.69‐0.98) and 23% at 24 months (IRR = 0.77; 95% CI = 0.65‐0.90). A 10% increase in the proportion of residents with the medical director as primary physician was associated with a 4% reduction in prescribing (IRR = 0.96; 95% CI = 0.92‐0.99). Incidence of C. difficile and MRSA infections, hospitalizations, and hospital readmissions did not change significantly. No adverse events from antibiotic nonprescription were reported. Estimated 2‐year implementation costs per NH, exclusive of medical provider time, ranged from $354 to $3653.

CONCLUSIONS

Antibiotic stewardship programs can be successfully disseminated in community NHs through either NH administration or medical provider groups and can achieve significant reductions in antibiotic use for at least 2 years. Medical director involvement is an important element of program success. J Am Geriatr Soc 68:46–54, 2019

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A Statewide Program to Improve Management of Suspected Urinary Tract Infection in Long‐Term Care - American Geriatric Society

BACKGROUND/OBJECTIVES

Suspected urinary tract infection (UTI) is the most common indication for antibiotic use in long‐term care (LTC). Due to the high prevalence of asymptomatic bacteriuria, for which antibiotics are not warranted, these antibiotics are frequently unnecessary. We implemented a collaborative quality improvement program to improve the management of suspected UTI in LTC residents by increasing awareness of current guidelines, with a focus on decreasing treatment in the absence of symptoms.

DESIGN/INTERVENTION

Two separate collaboratives included workshops, webinars, and coaching calls.

PARTICIPANTS

A total of 31 facilities participated in the first collaborative, with 17 submitting sufficient data for analysis and 34 in the second, with data analyzed from 25.

MEASUREMENTS

Facilities reported monthly numbers of urine cultures, UTI diagnoses, Clostridioides difficile infections (CDIs), and resident days.

RESULTS

When comparing the baseline period to the first collaborative period, the intercollaborative period to the second collaborative period, and the first collaborative period to the second, the incident rate ratios (95% confidence intervals) were 0.74 (0.68‐0.81), 0.83 (0.73‐0.94), and 0.63 (0.57‐0.69), respectively, for urine culturing rate; 0.73 (0.64‐0.83), 0.86 (0.70‐1.05), and 0.60 (0.51‐0.69), respectively, for UTI diagnosis rate; and 0.56 (0.40‐0.82), 1.61 (0.71‐4.14), and 0.45 (0.27‐0.74), respectively, for CDI rate.

CONCLUSION

The program we implemented was associated with reductions in urine cultures, UTI diagnosis, and CDI; and it suggests that this type of intervention can promote appropriate management of UTI in the LTC setting. J Am Geriatr Soc 68:62–69, 2019

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Matching Older Research Subjects to Disease Demographics: First You Need to Know the Demographics - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 1, Page 218-219, January 2020.

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Reply to Comment on Low‐Value Prostate Cancer Screening Among Older Men Within the Veterans Health Administration - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 1, Page 220-221, January 2020.

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Comment on Low‐Value Prostate Cancer Screening among Older Men within the Veterans Health Administration - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 1, Page 219-220, January 2020.

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Reply to Changes in Institutionalized Older People's Dentition Status in Helsinki 2003 to 2017 - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 1, Page 223-224, January 2020.

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Changes in Institutionalized Older People's Dentition Status in Helsinki, 2003‐2017 - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 1, Page 221-223, January 2020.

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Screening for Adverse Drug Reactions in Dementia Patients on Cholinesterase Inhibitor Therapy - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 1, Page 216-218, January 2020.

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Healthcare and Policy: Center Stage for Geriatric Research - American Geriatric Society

Journal of the American Geriatrics Society, Volume 68, Issue 1, Page 7-8, January 2020.

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Statement from FDA Commissioner Scott Gottlieb, M.D., in response to GAO report regarding FDA’s ongoing commitment to employing a least burdensome approach to device review - FDA Press Releases

Statement from FDA Commissioner Scott Gottlieb, M.D., in response to GAO report regarding FDA’s ongoing commitment to employing a least burdensome approach to device review

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Statement from FDA Commissioner Scott Gottlieb, M.D. responding to report from GAO and updating on FDA’s ongoing efforts to increase access to complex generic drugs - FDA Press Releases

GAO issued the report “Generic Drugs: FDA Should Make Public Its Plans to Issue and Revise Guidance on Nonbiological Complex Drugs,” which contains a single recommendation for the FDA -- that the agency publicly announce its plans to issue or revise guidance for these drug products. The FDA agrees and is actively working to accomplish this goal.

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Statement from FDA Commissioner Scott Gottlieb, M.D., on new steps to advance medical device innovation and help patients gain faster access to beneficial technologies - FDA Press Releases

Enabling patients and providers to have efficient access to new and innovative medical products that meet the FDA’s gold standard for safety and effectiveness is a core part of our mission. We’re advancing these goals as part of the Medical Innovation Access Plan that I announced earlier this year. While we’ve unveiled parts of that plan already, we’ll be releasing its full detail shortly. As one part of that effort, we’re announcing some additional steps we’re taking right now to promote beneficial medical device innovation.

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Statement from FDA Commissioner Scott Gottlieb, M.D., on new efforts to enhance and modernize the FDA’s approach to medical device safety and innovation - FDA Press Releases

The FDA is releasing the Medical Device Safety Action Plan that outlines our vision for how FDA can continue to enhance our programs and processes to assure the safety of medical devices

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An aberrant metabolic flow toward early shunt products in the granaticin biosynthetic machinery of Streptomyces vietnamensis GIMV4.0001 - Journal of Antibiotics

The Journal of Antibiotics, Published online: 10 January 2020; doi:10.1038/s41429-019-0267-8

An aberrant metabolic flow toward early shunt products in the granaticin biosynthetic machinery of Streptomyces vietnamensis GIMV4.0001

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Multimorbidity in Medicare Beneficiaries: Performance of an ICD‐Coded Multimorbidity‐Weighted Index - American Geriatric Society

OBJECTIVES

Most older adults have multimorbidity that impairs physical functioning, but it is difficult to quantify using claims data. We previously developed and validated a multimorbidity‐weighted index (MWI) that embeds physical functioning through disease weightings. We mapped these conditions to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes and compared them with existing indices.

DESIGN

Population‐based prospective cohort.

SETTING

Respondents to the 2006‐2016 waves of the Health and Retirement Study (HRS) with linked Medicare claims data and continuous enrollment in 2006.

PARTICIPANTS

Community‐dwelling Medicare‐eligible HRS participants (N = 9923; mean age = 75.5 ± 8.5 y).

MEASUREMENTS

Individuals were followed for future physical functioning (2006‐2014) and mortality (2007‐2016). MWI conditions were mapped to ICD‐9‐CM codes to produce an ICD‐coded MWI (MWI‐ICD). We compared MWI‐ICD, simple disease count, Charlson, Elixhauser, and the health‐related quality of life comorbidity index (HRQOL‐CI) through distributions, hazard ratios for mortality, and relationships with future physical functioning.

RESULTS

MWI‐ICD exhibited the broadest distribution and most unique values (5891). Left censoring was most pronounced for Charlson (34.3% score = 0) and Elixhauser (13.1% score = 0) vs MWI (5.0% score = 0). Hazard ratios and concordance (C)‐statistics for mortality across extreme quartiles were similar for MWI‐ICD, Elixhauser, and Charlson but lower for disease count and the HRQOL‐CI. For physical functioning, MWI‐ICD yielded the greatest contrast across extreme quartiles and overall coefficient of determination (R²).

CONCLUSION

MWI‐ICD was significantly associated with mortality and future physical functioning and comparable with established metrics for mortality prediction although not weighted to mortality. MWI‐ICD successfully captures diseases accumulation and functioning in claims data.

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Older Adults Hospitalized for Pneumonia in the United States: Incidence, Epidemiology, and Outcomes - American Geriatric Society

OBJECTIVES

To define the current incidence, epidemiology, and mortality of older adult patients hospitalized with community‐acquired pneumonia (CAP) in Louisville, KY and thus estimate the burden of CAP in the older adult population of the United States. To define risk factors associated with early and late outcomes.

DESIGN

This was a secondary analysis of older adults (aged ≥65 years) from the University of Louisville Pneumonia Study, a prospective population‐based cohort study of all hospitalized adults with CAP between June 1, 2014, and May 31, 2016.

SETTING

The study took place in all nine acute care hospitals for adults in Louisville, KY.

PARTICIPANTS

Residents in the city of Louisville, KY, who were diagnosed with CAP between the inclusion dates were included and who were aged 65 years or older.

MEASUREMENTS

Incidence of CAP and outcomes were measured. A total of nine risk factors were also assessed for any potential association with time to clinical stability, length of stay (LOS), and mortality.

RESULTS

During the 2‐year study, from a Louisville population of 102 264 adults aged 65 years or older, 4760 were hospitalized with CAP. The incidence of older adults hospitalized with CAP was 2093 per 100 000 population. This corresponds to 967 470 older adults in the United States hospitalized per year with CAP. The median time to clinical stability was 2 days, and the median LOS was 6 days. The 30‐day all‐cause mortality was 17%. The 1‐year all‐cause mortality was 38% (829 patients), which corresponds to 361 982 deaths in the United States with CAP in older adults.

CONCLUSION

The estimated burden of CAP in older adults is substantial in the United States. Nearly 1 million older adults are hospitalized for CAP, and over a third of those die within 1 year.

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COMMENT ON: USING POINT‐OF‐CARE ULTRASOUND ON HOME VISITS - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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REPLY TO: USING POINT‐OF‐CARE ULTRASOUND ON HOME VISITS - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Comment on the Influence of Smoking Status on the Health Profiles of Older Chinese American Men - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Isolation and structure determination of a new antibacterial peptide pentaminomycin C from Streptomyces cacaoi subsp. cacaoi - Journal of Antibiotics

The Journal of Antibiotics, Published online: 10 January 2020; doi:10.1038/s41429-019-0272-y

Isolation and structure determination of a new antibacterial peptide pentaminomycin C from Streptomyces cacaoi subsp. cacaoi

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FDA approves the first targeted therapy to treat a rare mutation in patients with gastrointestinal stromal tumors - FDA Press Releases

FDA approved Ayvakit (avapritinib) for the treatment of adults with unresectable or metastatic gastrointestinal stromal tumor (GIST) harboring a platelet-derived growth factor receptor alpha (PDGFRA) exon 18 mutation

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FDA, USDA and EPA announce joint platform to streamline information about agricultural biotechnology products - FDA Press Releases

FDA, USDA and EPA launch Unified Website for Biotechnology Regulation to streamline information about agriculture biotechnology products.

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Amycolatopsis pithecelloba sp. nov., a novel actinomycete isolated from roots of Pithecellobium dulce in Thailand - Journal of Antibiotics

The Journal of Antibiotics, Published online: 08 January 2020; doi:10.1038/s41429-019-0271-z

Amycolatopsis pithecelloba sp. nov., a novel actinomycete isolated from roots of Pithecellobium dulce in Thailand

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The Risk of Head Injuries Associated With Antipsychotic Use Among Persons With Alzheimer's disease - American Geriatric Society

BACKGROUND/OBJECTIVES

Antipsychotic use is associated with risk of falls among older persons, but we are not aware of previous studies investigating risk of head injuries. We studied the association of antipsychotic use and risk of head injuries among community dwellers with Alzheimer's disease (AD).

DESIGN

Nationwide register‐based cohort study.

SETTING

Medication Use and Alzheimer's Disease (MEDALZ) cohort, Finland.

PARTICIPANTS

The MEDALZ cohort includes Finnish community dwellers who received clinically verified AD diagnosis in 2005 to 2011. Incident antipsychotic users were identified from the Prescription Register and matched with nonusers by age, sex, and time since AD diagnosis (21 795 matched pairs). Persons with prior head injury or history of schizophrenia were excluded.

MEASUREMENTS

Outcomes were incident head injuries (International Classification of Diseases, Tenth Revision [ICD‐10] codes S00‐S09) and traumatic brain injuries (TBIs; ICD‐10 codes S06.0‐S06.9) resulting in a hospital admission (Hospital Discharge Register) or death (Causes of Death Register). Inverse probability of treatment (IPT) weighted Cox proportional hazard models were used to assess relative risks.

RESULTS

Antipsychotic use was associated with an increased risk of head injuries (event rate per 100 person‐years = 1.65 [95% confidence interval {CI} = 1.50‐1.81] for users and 1.26 [95% CI = 1.16‐1.37] for nonusers; IPT‐weighted hazard ratio [HR] = 1.29 [95% CI = 1.14‐1.47]) and TBIs (event rate per 100 person‐years = 0.90 [95% CI = 0.79‐1.02] for users and 0.72 [95% CI = 0.65‐0.81] for nonusers; IPT‐weighted HR = 1.22 [95% CI = 1.03‐1.45]). Quetiapine users had higher risk of TBIs (IPT‐weighted HR = 1.60 [95% CI = 1.15‐2.22]) in comparison to risperidone users.

CONCLUSIONS

These findings imply that in addition to previously reported adverse events and effects, antipsychotic use may increase the risk of head injuries and TBIs in persons with AD. Therefore, their use should be restricted to most severe neuropsychiatric symptoms, as recommended by the AGS Beers Criteria®. Additionally, higher relative risk of TBIs in quetiapine users compared to risperidone users should be confirmed in further studies.

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Planning for a Safe Discharge: More Than a Capacity Evaluation - American Geriatric Society

Discharge decision making for hospitalized older adults can be a complicated process involving functional assessments, capacity evaluation, and coordination of resources. Providers may feel pressured to recommend that an older adult with complex care needs be discharged to a skilled nursing facility rather than home, potentially contradicting the patientʼs wishes. This can lead to a professional and ethical dilemma for providers, who value patient autonomy and shared decision making. We describe a discharge decision‐making framework focused on interprofessional evaluation and management, longitudinal follow‐up, and education and support for patients and families. By gathering and synthesizing information, eliciting goals and preferences, and identifying community resources, the healthcare team can help maximize independence for vulnerable older adults.

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Thirty Minutes with the Sadness of Dementia, on a Good Day - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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COMMENT ON: THE CLINICAL COURSE AFTER LONG‐TERM ACUTE CARE HOSPITAL ADMISSION AMONG OLDER MEDICARE BENEFICIARIES - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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REPLY TO COMMENT ON: THE CLINICAL COURSE AFTER LONG‐TERM ACUTE CARE HOSPITAL ADMISSION AMONG OLDER MEDICARE BENEFICIARIES - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Acknowledgments - Journal of Antibiotics

The Journal of Antibiotics, Published online: 06 January 2020; doi:10.1038/s41429-019-0253-1

Acknowledgments

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Remembering Dr Herbert A. Kirst (22 September 1944–25 September 2019) - Journal of Antibiotics

The Journal of Antibiotics, Published online: 06 January 2020; doi:10.1038/s41429-019-0259-8

Remembering Dr Herbert A. Kirst (22 September 1944–25 September 2019)

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FDA finalizes enforcement policy on unauthorized flavored cartridge-based e-cigarettes that appeal to children, including fruit and mint - FDA Press Releases

FDA finalizes enforcement policy on unauthorized flavored cartridge-based e-cigarettes that appeal to children, including fruit and mint

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